Plastic surgery sometimes gets played, pedaled and plugged as an irresistible tsunami overpowering its primary targets, women between 35 and 50.
But this year we have some gratifying news to digest: The tide has been turning.
Half of plastic surgeons report their practices were down last year. That was before the worst of the recession, so it's not just a matter of cost or insurers who only cover operations that fix "deformities" or improve healthy functioning.
From 2004 to 2005, liposuction was down 5 percent; eyelid surgery down 20 percent. Even less-invasive procedures such as microdermabrasion and chemical peels were down in that same time period, by 7 percent and 50 percent respectively, according to the American Society for American Plastic Surgery.
It's also a matter of growing cultural aversion toward the results. "Scary" is emerging as an increasingly common adjective for the surgeons, procedures and -- more frequently -- the results.
'Before and After' Galleries
Web sites with names such as "Plastic Surgery Disasters" and "The 15 Worst Celebrity Plastic Surgery Disasters You Will Ever See" have developed cautionary before-and-after galleries.
"Before" shows attractive men and women of all ages, including celebrities. "After" shows women with cavities in Barbie-sized breasts; men with hyper-wide eye-lifts. One Flickr site invites, "Caption This Disaster."
The anti-plastic tone can often be cruel and jeering: "You wanted this look? You think this looks good?" Sometimes it's rueful, such as a recent New Yorker cartoon of a young couple lovingly holding hands. "I want someone I can grow old and have plastic surgery with," she says.
"Anti-aging surgery" is becoming a misnomer. Dr. Pauline Chen, the surgeon who wrote "Final Exam," describes an older surgeon, after "countless submissions" to the knife, as having skin "like plastic wrap stretched tightly over a bowl." Designer Isaac Mizrahi says, with ageist malice, "If you want to look 70, get a facelift."
The pushback extends to stars such as Ashley Tisdale. In People recently, the young actress went out of her way to say her five-hour operation to repair a deviated septum wasn't plastic surgery, which she wouldn't recommend to anybody.
Resistance can also take the form of support for those who resist "getting done."
The thoughtful film critic Wesley Morris, for instance, praises the face of Melissa Leo, a 40-year-old actress in "Frozen River," for its "amazing and unlimited capacity for solemnity, grief, despair and rage. If you've been to a movie lately, you know what an un-nipped, untucked, Botox-free miracle that face is."
Resisters in the Majority
This type of feedback and commentary is complemented by a majority who oppose surgical fixes for themselves. According to a Nielsen study of women around the globe, 80 percent would never "go under the knife." Data from the American Society for Aesthetic Plastic Surgery itself indicate that 69 percent of U.S. women do not think it an option for themselves.
Why don't we ever hear that nonusers -- many of them resisters -- far outnumber potential users?
People actively opposed have a point of view that rarely gets heard and a social milieu that is entirely supportive of them.
According to interviews collected by sociologist Abigail Brooks for her absorbing 2007 Boston College dissertation, resisters are often dismayed at the way surgery survivors look.
A woman in Brooks' study described a friend who lost "the most gorgeous, beautiful eyes, they were her redeeming feature. . . The bags are gone but the shape is different." "Her eye is crooked, definitely," another of Brooks' interviewees reports thinking. A woman with an eye-lift looked as startled as a "deer in the headlights." Another said she found it "exhausting" to interact with a woman whose facelift gave her an intense "wind-tunnel" look.
"Normal" is a goal for many who undergo plastic surgery. They often say they know surgery won't make them look "beautiful" so normal is their aim. But it turns out their friends think "normal" is the way they used to look.
Even Nora Ephron, who made some women feel bad about their necks, admits, "It's a scary thing, when you have friends you don't actually recognize."
This is the real majority speaking, and it's turning against the trend.
Disappointment is built into the practice, and is not limited to so-called addicts. Many decide after one experience that it was enough. Women are writing books -- like Alix Kuczynski's "Beauty Junkies" -- that declare "never again." After age 50, the percentage of users drops by almost half. The so-called boomers are halfway through the dangerous age.
The conspiracy of silence is breaking down. The death a year ago of hip-hop star Kanye West's mother, college teacher Donda West, after a five-hour operation for multiple cosmetic procedures, sent a wake-up call.
No Guarantee of Survival
Certification in the best hospitals is no guarantee even of survival. Two women died in 2004 at Manhattan Eye Ear and Throat; one was Olivia Goldsmith, author of "The First Wives' Club." The death rate from liposuction is 1 in 5,000 procedures.
Some 40 percent of breast augmentations will entail complications within three years. The dreaded MRSA (methicillin-resistant staph infection) is turning up also in some patients who undergo face lifts.
Any licensed medical doctor can perform cosmetic surgeries. "It is ironic that the doctors who choose to perform an operation that is solely cosmetic are willing to accept mortality and complication rates significantly higher than those who restrict their interventions to those required for the treatment of disease," writes Dr. Sherwin Nuland, author of "The Art of Aging and How We Die."
David Heilbroner, co-director of the 2006 HBO special "Plastic Disasters," explained in an interview why it's hard to learn about the dangers. "Doctors settle lawsuits, which then stay off the books. There's no national center collecting data on botched surgery."
Even when outcomes go relatively well, several respondents told Brooks they did not share with their friends how much pain they had endured. When one woman complained of being lied to, her friend said, "Well, if you told people how painful this would be they'd never do it."
Plastic surgery is becoming a public-health issue in need of regulation. And we'll hear more about its dangers from the competition -- providers of non-surgical procedures like Botox -- who have money to spend.
The other critics, at this point, are numerous. They include vindictive bloggers, disapproving fashionistas, disillusioned ex-users, legions of un-retouched women, concerned doctors, feminist anti-ageists, sociologists and women's health activists.
I'm not holding my breath about rapidly transforming the commerce in aging in America. The cult of youth is ever-present in the magazines, TV and films; hurting women's self-esteem as they grow older. Men are being affected and joining the ranks of users. In some zip codes parents are giving teen daughters silicone breasts as a birthday present.
But despite such dismaying and attention-getting facts, the larger, less-told story is that most of us as we get older see ourselves and our friends as just fine exactly the way we are.
Here's to happier eyes!
<i>Copyright 2008 Women's eNews. All Rights Reserved.</i>